Credit: iStockphoto.com/sureyya akin
The UK government’s plans to reform the National Health Service are at the heart of a new political storm. Health Secretary Andrew Lansley claims the Health and Social Care Bill, currently undergoing amendment in the House of Lords, will increase private-sector competition for NHS funding and reduce bureaucracy. He has the backing of the Prime Minister, but is facing growing opposition both in Westminster and from the health professions. More than 130,000 people have signed an online petition calling for the Bill to be dropped, the Royal Colleges are critical, and even influential voices within the Conservative party have called it an electoral liability.
With political passions running high, it is important to evaluate the evidence base for policy change. The Faculty of Public Health & Policy at the London School of Hygiene & Tropical Medicine is Europe’s largest centre for public health research, teaching and policy advice, with in-depth knowledge of health systems, and experience evaluating the impact of policy on patient care outcomes for the UK Department of Health, the EU and and other government agencies worldwide.
In a paper titled Declining health-care productivity in England: the making of a myth published in The Lancet on Monday 13 February, Professor Nick Black suggested that despite the ‘myth’ of declining productivity under the previous government, NHS productivity has “almost certainly” risen in the past decade. His suggestion that taxpayers have actually been getting more out of the health service for their money made media headlines, and has been used to undermine one of the key arguments for the reforms.
Earlier this month, Professor Martin McKee wrote an editorial in the BMJ asking Does anyone understand the government’s plan for the NHS? Among his concerns are the government’s argument that reform is needed because the NHS is performing so badly, while the evidence shows this is not the case. He also questions how management of a hospital by a private equity consortium is consistent with the Prime Minister’s assurance that the reforms will not mean privatisation of the NHS.
The NHS reform raises questions about increasing the use of competitive markets in healthcare delivery for patient care and Dr Lucy Reynolds, whose experiences of health service provision around the world drives her commitment to informing the debate over the future of the NHS, has undertaken extensive analysis of the current situation.
Writing in The Guardian in relation to the PIP breast implant scandal, Dr Reynolds said the fallout raises questions about the relationship of private medicine to public healthcare provision.
“The health and social care bill now in the Lords contains no provision to penalise providers who deliver inferior services that generate costs for other providers or injure patients. In a highly competitive market, provider failure is more likely, and an appropriate procedure to address the consequences is lacking. For patients this will mean less access to care for some, and unneeded treatment for others in order to make money for providers, which may cause harm as well as inconvenience. The taxpayer will have to finance the costly new layers of bureaucracy needed to run competitive markets in health care, as well as to pay for all the overtreatment generated.”
She concluded: “It’s worth noting that the passage of the bill will allow the Secretary of State for Health to wash his hands of any future events of this kind. There will no longer be any redress for medical errors except through the courts, and then only for those who can pay a legal team to pursue their case.”
In a recent joint article on the implications of the clinical commissioning regime, Professor McKee and Dr Reynolds highlight the conflicts of interest intrinsic to the new arrangements, and in particular their impact on trust in GPs once patients become aware that their doctor may profit financially by denying NHS-funded care.
They also contributed earlier this month to a paper in The Lancet about the legal content and operational impact of the Health and Social Care Bill, and co-wrote a user-friendly Frequently Asked Questions guide to the Bill for those who would like to know more about the NHS reforms.
Adding his expertise to the arena is Professor Nicholas Mays who, with Judith Smith from the Nuffield Trust, has investigated the evidence for the government’s focus on GP led commissioning in the BMJ this week. Using the evidence on previous initiatives, the paper highlights the likely limitations of new commissioning groups and suggest some changes.
(Image: Illustration of a cardiogram. Credit: iStockphoto.com/sureyya akin)